Rerun: Chastising Aimee

The Health Business Blog is on summer vacation until Labor Day, and has been re-running some classic posts for the past two weeks. This is the last one.This item originally ran on April 24, 2008. It's one of a number of posts I've run encouraging the medical profession to take more care to limit radiation doses from imaging. If you'd like to comment, please do so on the original post.American Imaging Management (AIM), a radiology cost containment company owned by health insurer WellPoint, has a web-based patient exposure tool called Aimee that provides information for doctors and patients about the amount of radiation associated with various scans.The site is well-designed and easy to use. Simply click on the relevant scan and portion of the anatomy and the site provides a summary of the purpose of the exam and suggests safer alternatives when appropriate. At the bottom of the page is a display that expresses the radiation exposure in millisieverts (mSv) and as its equivalent in chest x-rays and background exposure. I like the site because it raises awareness about radiation exposure and provides alternative recommendations patients could discuss with their physicians.According to AuntMinnie, a radiology news and information site, some physicians are less sanguine. See Criticism aimed at radiation-estimate Web site. Among the complaints:

1. Ownership of the site by a party that has a stake in reducing imaging costs
2. The site’s oversimplification, e.g., not specifying that radiation exposure depends on equipment and protocol, not just the type of scan category
3. The inappropriateness of making comparisons with chest x-rays (e.g., for scans that target other parts of the body) and background exposure (because the exposure comes over time rather than all at once)
4. Lack of relevance for pediatric patients, who will get lower exposures
5. Lack of discussion of the benefits of imaging

Some of these criticisms are reasonable and I hope AIM takes them into account as it updates Aimee. Still, I don’t think they’re completely fair:

1. Ownership: As long as AIM’s information is objective, I don’t think it matters who owns the site.
2. Oversimplification: I’m sure there are improvements that can be made, but I don’t know if that would really make the information more useful. Perhaps just indicating that there is a range would be enough. This criticism sounded more like an objection to having the information posted at all.
3. Appropriateness of comparisons: Since most people don’t understand mSv, the other comparisons are at least somewhat helpful. And it’s not as dramatic as comparing the exposure to the level of radiation received by atomic bomb survivors, which I’ve also seen!
4. Pediatric: This is an important consideration. On the other hand, as the Image Gently folks have described, pediatricians and radiologists have plenty of room for improvement on radiation exposure practices. Casting stones at Aimee won’t really help.
5. Lack of discussion of benefits: Imaging is a large, rapidly growing contributor to medical spending. There’s no particular need for Aimee to talk about imaging’s benefits.

---If you'd like to comment, please do so on the original post.